AB0123 IMPACT OF TOBACCO ON PRIMARY SJÖGREN SYNDROME: ANALYSIS OF THE FRENCH COHORT ASSESS
Authors: L. Pacoureau, J. E. Gottenberg, G. Nocturne, E. Dernis, M. Couderc, V. Le Guern, X. Mariette, R. Seror
Journal: Annals of the Rheumatic Diseases (2022)

Background It has been shown that smoking could be negatively associated with the risk of developing primary Sjögren’s Syndrome (pSS), and that amongst smoking pSS patients, seropositivity for anti SSA antibodies and frequency of focal sialadenitis were lower. However, data are scarce concerning the impact of smoking on disease activity, glandular features, patient reported outcomes (PROs) and disease progression. Objectives To describe the impact on smoking on pSS disease characteristics and outcome. Methods ASSESS (Assessment of Systemic Signs and Evolution in Sjögren’s Syndrome) is a French prospective multicenter, longitudinal cohort involving 395 patients with pSS enrolled in 15 French centers between 2006 and 2009 and followed since then. In these patients, we compared baseline characteristics and outcome (change in activity and PROs) during the first 5 years of follow-up, according to their smoking status (ever/never). For change during follow-up, any change of ≥ 3 points of ESSDAI or ≥ 1 point of ESSPRI or individual VAS, ≥ 25% of unstimulated salivary flow (UWSF) were considered. Results Data on smoking at inclusion were available for 394 patients, 106 (26.9%) of them were ever-smokers. Compared to never smokers, ever-smokers were significantly younger (54.0 ± 11.3 vs 59.2 ± 12.2, p &lt; 0.001), and more frequently men (14 (13.2%) vs 12 (4.2%), p = 0.0013). The mean ESSDAI did not differ according to smoking status, (5.0 ± 4.9 vs 5.5 ± 5.8, p = 0.436). There were no significant differences regarding the use of corticosteroids (49 (46.2%) vs 159 (55.2%), p = 0.113), immunosuppressive drugs (21 (19.8%) vs 77 (26.7%), p = 0.158), or hydroxychloroquine (49 (46.2%) vs 165 (57.3%), p = 0.05), even though numerically less smokers were taking these treatments. Smokers tended to have a lower dryness VAS and were less likely to use treatment for dry mouth (64 (60.4%) vs 210 (73%), p = 0.016). No difference was observed in PROs (ESSPRI 5.2 ± 2.2 vs 5.5 ± 2.1, p = 0.259), and in UWSF (0.5 ± 0.75 vs 0.4 ± 1.0, p = 0.672) between smokers and non-smokers. After five years, no difference in change of disease activity (ESSDAI change ≥ 3 points: 12/77 (15.6%) vs 30/207 (14.5%), p = 0.818), or in PROs (ESSPRI change ≥ 1: 30/70 (42.9%) vs 91/198 (46%) p = 0.654) was observed according smoking status, as well as no change in dryness (p = 0.968), pain (p = 0.280), fatigue (p = 0.605) or in UWSF (p = 0.132). Table 1. Baseline characteristics and change in patient-reported outcomes at 5 years Baseline Smokers n = 106 Non smokers n = 288 p -value Age (years) 54.0 ± 11.3 59.2 ± 12.2 0.00008 Sex, females 92 (86.0) 276 (95,8) 0.0013 Disease duration (years) median [IQR] 3.9 [1.1; 8.7] 5.5 [2.6; 9.7] 0.257 ESSPRI 5.2 ± 2.2 (n = 97) 5.5 ± 2.1 (n = 267) 0.259 Dryness 4.9 ± 2.5 (n = 98) 5.5 ± 2.2 (n = 270) 0.053 Fatigue 5.9 ± 2.8 (n =101) 6.0 ± 2.6 (n = 275) 0.924 Pain 4.6 ± 2.8 (n = 101) 4.9 ± 2.9 (n = 274) 0.359 Unstimuled salivary flow (mL/min) 0.5 ± 0.75 (n = 89) 0.4 ± 1.0 (n = 241) 0.672 Treatment for dry mouth 64 (60.4) 210 (73.0) 0.016 ESSDAI 5.0 ± 4.9 (n = 104) 5.5 ± 5.8 (n = 281) 0.436 Corticosteroids 49 (46.2) 159 (55.2) 0.113 Hydroxychloroguine 49 (46.2) 165 (57.3) 0.050 Immunosuppresive drugs 21 (19.8) 77 (26.7) 0.158 Lymphocytes count (/mm 3 ) 1661.1 ± 919.3 1492.1 ± 1072.0 (n = 280) 0.128 After five years Change in ESSDAI ≥ 3 12 (15.6) (n = 77) 30 (14.5) (n = 207) 0.818 Change in ESSPRI ≥ 1 30 (42.9) (n = 70) 91 (46.0) (n = 198) 0.654 Change in salivary flow ≥ 25% 29 (44.6) (n = 65) 55 (34.0) (n = 162) 0.132 Data are given as mean ± SD or n (%) unless otherwise specified. SD, standard deviation; IQR, interquartile range; ESSPRI, EULAR Sjögren’s Syndrome Patient Reported Index; ESSDAI, EULAR Sjögren’s Syndrome Disease Activity Index. Continuous variables were compared using student t test and qualitative variable using chi-square Conclusion Smokers pSS patients are more likely to be men and younger than non-smokers. Ever smokers tended to have less dryness, and take less frequently treatment for dryness, corticosteroids, hydroxychloroquine or immunosuppressants. After five years, no difference was observed, according to smoking status, in terms of change in disease activity or PROs. Disclosure of Interests None declared